PROGNOSIS: NURSES WANTED

Increased demand for health services and professionals’ retirements both driving the need for additional RNs

After several years in the doldrums, demand for registered nurses is on the cusp of a resurgence.

California labor officials estimate that nearly 10,000 new slots for registered nurses will open each year between now and 2020, half from increased demand for health services and half from retirement of aging nurses.

That contrasts with recent years, when many newly minted nurses struggled to find their first job in the field, sometimes searching for months or having to move out of San Diego County or the state to secure employment.

Nationwide, the federal government projects an increase of at least 25 percent in the number of registered nurses during the next decade or so.

Analysts cite factors such as technological advancements — including nurses knowledgeable in paperless systems, computer charting and new diagnostic techniques — increased emphasis on preventive care and baby boomers seeking more medical support as they live longer and more active lives.

The heydays of the early 2000s, when a major nursing shortage resulted in higher wages, signing bonuses and lucrative deals for nurses willing to travel for short- to moderate-term assignments isn’t quite back, but there’s little doubt that nurses are expected to be in high demand again.

Obamacare, more formally known as the Affordable Care Act, is expected to add as many as 30 million Americans to the health care system, including about 3 million in California.

“We’re starting to see a robust market out there,” said Marcia Faller, chief clinical officer for AMN Healthcare in San Diego, a nurse, physician and therapist staffing service. “And we’re already starting to see the impact of the Affordable Care Act.”

Sharp HealthCare recruiting director Michael Peterson said what has been a relatively stable market for nurses is turning a corner.

“The long-term potential is good, not just from the expansions expected through health care reform but also because … the average age of nurses is nearing the horizon for retirement.”

Sharp, which employs about 3,500 nurses at its facilities around San Diego County, has drawn up a variety of scenarios accounting for increased retirements, the aging population and the expansion of health services.

“The initial impact will be on primary care, but we’re uncertain about the impact on acute care,” Peterson said.

Landing work

A decade ago, new nurses “could walk out of school and have a job just like that,” said Debbie Yaddow, dean of the nursing program at Grossmont College.

At the time, state officials and hospital administrators were citing a shortage of nurses that ran as high as 30,000 in California. That sent salaries soaring, spurred employers to offer numerous recruitment incentives and led to a $90 million infusion of funding to expand nursing programs under then-Gov. Arnold Schwarzenegger’s California Nurse Education Initiative.

But when the Great Recession took hold in 2008, the market dried up. Nurses who were planning to retire put that off as they saw the value of their 401(k) plans shrink, along with the market value of their homes. Many also became their household’s sole wage earner.

“As the economy improves, it appears a lot are going to retire or go part-time,” said Denise Boren, director of the School of Nursing at California State University San Marcos. “During the recession, a lot who were part-time went to full time.”

Her school has about 500 students and will graduate 120 this spring. A majority should be able to find work quickly, mostly within the area, she predicted.

“About 60 percent are getting jobs right away, and I hope that picks up with Obamacare and its increased nursing focus,” Boren said.

Most hospitals in the county have hiring programs focused on new graduates, allowing the cream of each graduating crop to get their foot in the door if they’re interested in that work environment.

‘Awesome job’

Megan McCluney of Murrieta is among those hoping to get such a slot when she graduates in May 2014.

“My number-one job would be in an E.R. — that would be awesome,” said McCluney, who spends one day a week in the intensive-care unit at the San Diego VA Medical Center as part of her instruction.

Many nurses and nursing students are also considering advanced education to become nurse practitioners, another job seen as being on the verge of a huge spike in demand.

Nurse practitioners can prescribe medications and perform many of the basic examinations, diagnoses and treatments that doctors do. Half of the nation’s states — California is not one of them — allow such nurses to practice independent of physicians. A bill now in the Legislature would grant that authority in California.

At the federal level, the Affordable Care Act is expected to emphasize preventive care and outpatient services delivered in community clinics, instead of hospitals where people come for treatment of medical emergencies, according to Grossmont’s Yaddow.

“Everything is moving to prevention and early intervention, and that means an expanding role for nurses,” she said. “Some of the hospitals that are most profitable today may wind up empty.”

Her school’s graduates are already seeing the upswing in demand.

“We have one of the higher placement rates for new graduates, with 78 percent finding jobs a short time after leaving,” Yaddow said. “It was less than 50 percent at the height of the recession.”

She’s also an advocate for expanding the scope of what registered nurses are able to do as a way to meet increased demand from patients.

“A nurse can tell whether someone who comes in with the common cold does or doesn’t need an antibiotic,” she said. “Nurses should be able to do that.”

Phil Greiner who directs San Diego State University’s School of Nursing, agrees that some of the prohibitions on nursing duties need easing.

“If we take away the scope of restrictions and allow RNs and nurse practitioners to practice to their fullest ability, we can probably handle up to 80 percent of the influx from the Affordable Care Act,” he said.

From an academic perspective, the law may also reshape how nurses are taught and what patients will want from their health providers.

“The assumption is that patients and their families and communities will become more active in the provision of care,” Greiner said. “The question is what these groups expect of us as nurses. What will be the new nurse’s role?”

Career incentives

Would the changing of roles correlate with a rise in pay?

Wages average about $84,000 a year for a registered nurse with at least five years of experience. There’s been little increase in pay during the recession and its immediate aftermath, and experts are unsure whether the projected rise in demand will cause wages to climb.

“The pay starts high, but it doesn’t go up much,” Greiner said. “But it’s still a darned good job compared to many others, and it’s highly portable.”

Martha Kuhl, ﻿treasurer of the California Nurses Association, counts herself in the group of nurses set to retire in the next two years or so.

After seeing wages in most union contracts remain flat for a few years, she said, more contracts with slight pay increases are being successfully negotiated. That includes the Bay Area, where Kuhl works; it saw a 6 percent increase in average salary over three years.

While pay and benefits are important, Kuhl said nursing is socially meaningful and should be attractive to anyone interested in science, ethics, teaching and advocacy. It also doesn’t hurt that Americans love nurses, giving them an 85 percent approval rate in the latest Gallup Poll of honesty and ethics among professionals.

“It’s useful and important for everyone, and there are many reasons to love it,” Kuhl said.

As she readies for her career in the burgeoning ranks of nurses, McCluney at Cal State San Marcos said such factors are her prime source of motivation.

“I like the aspect of always being with patients,” she said. “I like serving others — that’s your purpose as a nurse.”